After 10 years of unsuccessful efforts to raise cigarette taxes, anti-smoking activists are trying a new approach — a ballot initiative that would not only steeply increase taxes on tobacco products but also add them to previously untaxed electronic cigarettes.

If voters pass Proposition 56 in November, California would become only the fifth state to tax e-cigarettes, following Kansas, Louisiana, Minnesota and North Carolina6. Still, such action in the nation’s most populous state — and the first one to ban smoking in bars — could start a trend in the midst of a growing debate over how the multibillion-dollar vaping industry affects public health.

California voters defeated measures to raise cigarette taxes in 2006 and 2012, and the tobacco industry is strongly opposing this one, which would add $2 to the current 87 cents-a-pack state tax on cigarettes.

The industry has raised more than $56 million to defeat Proposition 56, while anti-smoking activists, supported by billionaire environmentalist Tom Steyer, medical groups and educators, have raised more than $20 million.

Anti-smoking advocates say the vapor liquids that come in candy flavors in e-cigarettes with labels featuring minions and friendly cartoon characters like Tinkerbell are being marketed to young people with the intention of hooking a new generation on nicotine.

“We’re facing a particularly alarming new public threat with the rising popularity of electronic cigarettes, especially among our youth,” said Dr. Ted Mazer, president-elect of the California Medical Association.

The vaping industry responds that its products are a better, safer alternative to smoking tobacco.

E-cigarettes heat liquid nicotine into a vapor, delivering the chemical that smokers crave without the harmful by-products generated from burning tobacco. That makes them a potentially useful tool to help smokers quit, industry officials say, adding that taxing them at the same rate as tobacco products could threaten that.

“Burdensome taxes on innovative tobacco products like e-vapor could impede adult consumer interest and therefore could interfere with the development of an effective and consistent national tobacco strategy,” said David Sutton, a spokesman for Altria Group Inc., which includes cigarette makers as well as the e-vapor company Nu Mark.

Ethan Maxwell, who says he once smoked several packs of cigarettes a days, agrees that a steep tax on e-cigarettes would make it tougher for other smokers to switch.

At the San Diego e-cigarette store he manages, a paper sign on a glass counter displaying colorful vape pens lists new federal regulations, the first for the industry. Paper signs throughout the store and on its front door also list new state rules.

Maxwell, who started smoking at 18, said he wasn’t motivated to try e-cigarettes just for his health. But in the end, he said, the switch cut his spending on smoking in half.

“For me, there’s no going back,” the 22-year-old businessman said as he blew out a sweet-smelling cloud that wafted past a board advertising 70 flavors, including graham cracker cream, vanilla custard and a tropical fruit blend dubbed “Yoda Brains.”

“But a couple of friends of mine would go back to cigarettes if this becomes a lot more expensive,” he said.

California’s legislative analyst and the state’s finance director say Proposition 56 could raise $1 billion to $1.4 billion in state revenue by the 2017-2018 year, with potentially lower annual revenues over time.

The measure calls for that money to go to California’s Medi-Cal fund, as well as anti-smoking campaigns and medical research.

California voters have not approved raising cigarette taxes since 1998. The state ranks 37th in the country on per-pack taxes, according to Campaign for Tobacco-Free Kids, an advocacy group that estimates that every 10 percent increase in cigarette prices can lead to as much as a 5 percent decline in cigarette consumption.

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